December 02, 2005

Europeans reject abstinence message in split with US on Aids

We continue to see a polarised debate about how to prevent HIV transmission between some of those in developed nations who tend to favour condoms above all else (sometimes perhaps to the exclusion of other options), and those in the poorest nations who often feel the case for abstinence and faithfulness is being ignored (and sometimes feel uncomfortable talking about condoms).

The dispute is confusing and in many ways unecessary.

We need a reality check: as the work of the AIDS foundation ACET (which I started in 1988) has found, the realities on the ground tend to impose their own solutions. Rhetoric and political posturing disappears when you are confronted by the magnitude of the disaster in countries with very few resources and health budgets of maybe only a couple of dollars per person a year.

Take for example the plight of Africa where at least 10% of the population in vast rural areas is already infected. Those that promote condoms as (virtually) the only way to halt spread don't seem to have worked out the logistical and economic challenge of applying a condom-dominated message across an entire low-income region.

The world AIDS budget is insufficient to supply every sexually active adult in Africa with as many condoms as they may need to protect every sexual encounter. Such a policy also assumes perfect distribution channels to villages which may be almost entirely cut off from Western-style supplies, and even date-checking of condom packets which deteriorate in tropical heat.

In any case, such an approach is deeply insulting to many in Africa since it ignores religious and other cultural values which in many places give honour to those who abstain before marriage and are faithful within it. There have been (totally false) widespread rumours that condom-dominated programmes are a front for secret Western attempts to stop babies being born in Africa. But these rumours have influenced many, and have come about because of mistrust of "imperialistic" wealthy nations.

And then there is the sensitive issue of youth. Even if one were to say that a condom-dominated message is the only right one for adults, and older teenagers, how about younger ones?

Is it right with a class of 11 year old girls to only talk about condoms, without raising the possibility that they might have an option to say no to sexual activity at such an age?

In practice, the pro-condom campaigners, and pro-abstinence activists tend to share common ground when tackling HIV education and prevention amongst those at such a young stage in life.

At the other extreme, most pro-abstinence activists also recognise that adults are determined to take a risk that could end their lives should be told about all the ways that such a risk can be reduced, including how to get hold of what they need eg condoms.

And between these two extremes, you will find the vast majority of HIV prevention programmes in Africa and Asia, looking to co-operate in doing all they can to educated people about risks, enabling them to take their decisions about how to stay healthy, in a culturally sensitive way, encouraging every avenue to save lives, whether condom use, refraining from risky sexual activity, not sharing needles and so on. And when it comes to avoiding sexual risk, as the World Health Organisation has always pointed out, there are two options: abstaining from penetrative sexual activity if the person could be infected (recognising you may never know), or being in a faithful relationship where both are known to be uninfected, and are both continuing to take every step to avoid becoming so.

We need every approach: sexual health clinics have a vital role to play in helping reduce other infections and an important co-factor for HIV spread; schools have a central task in informing young people about all health risks; parents have perhaps the greatest opportunity of all with young people growing up; the media, government, churches and other faith-based or community-based organisations likewise all have roles to play. Detached teams can target particular at-risk groups and so on.

This is not a time for disputes over how to put out the forest fire. We need everyone to pull together.

Unfortunately many people on every side of the debate tend to try to produce statistics to back their case. The trouble is that much of the science of prevention has been very weak. It is almost impossible to separate two different groups so that the only variable is your own programme. In almost all cases there are many other factors which could be operating to explain outcome differences. That is why so many of the studies show apparently conflicting results.

Rigorous studies are very hard to do and data that exists needs to be looked at very carefully.

However one thing is clear: advertisers have for years persuaded companies to spend huge amounts of money by proving that messages can change behaviour. Prevention programmes are an extension of the same process. They work.

We can debate about which approaches are most cost-effective, sustainable or culturally appropriate but as we have seen, when all parts of a community pull together, AIDS can be beaten.






Thursday December 1, 2005
The Guardian


Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

The statement, released for World Aids Day today, emphasises the fundamental importance of condoms, sex education and access to reproductive health services. "We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness," it says.


While the US is not named, there is widespread anxiety over the effect of its pro-abstinence agenda in countries such as Uganda, where statements by Janet Museveni, the president's wife, and alleged problems with supply have led to a serious shortage of condoms.

The US has pledged $15bn (?8.6bn) over five years to fight the disease, most of which is channelled through the President's Emergency Plan for Aids Relief (Pepfar). Pepfar grants come with conditions, however - two thirds of the money has to go to pro-abstinence programmes, and it is not available to any organisations with clinics that offer abortion services or even counselling. The US is also opposed to the provision of needles and syringes to drug users on the grounds that it could be construed as encouraging their habit.

But the statement from 22 EU member states, released at a meeting under the UK presidency in London yesterday, calls on developing world governments to use every prevention tool, from condoms to clean needles to sexual health clinics, in a bid to slow down ">Google Desktop Search: Europeans reject abstinence message in split with US on Aids: "Thursday December 1, 2005
The Guardian


Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

The statement, released for World Aids Day today, emphasises the fundamental importance of condoms, sex education and access to reproductive health services. 'We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness,' it says.


While the US is not named, there is widespread anxiety over the effect of its pro-abstinence agenda in countries such as Uganda, where statements by Janet Museveni, the president's wife, and alleged problems with supply have led to a serious shortage of condoms.

The US has pledged $15bn (?8.6bn) over five years to fight the disease, most of which is channelled through the President's Emergency Plan for Aids Relief (Pepfar). Pepfar grants come with conditions, however - two thirds of the money has to go to pro-abstinence programmes, and it is not available to any organisations with clinics that offer abortion services or even counselling. The US is also opposed to the provision of needles and syringes to drug users on the grounds that it could be construed as encouraging their habit.

But the statement from 22 EU member states, released at a meeting under the UK presidency in London yesterday, calls on developing world governments to use every prevention tool, from condoms to clean needles to sexual health clinics, in a bid to slow down "
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